Provider Demographics
NPI:1104588292
Name:PRIDE, MALIK (RBT)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:PRIDE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 HEIMER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5160
Mailing Address - Country:US
Mailing Address - Phone:210-885-3481
Mailing Address - Fax:210-504-5084
Practice Address - Street 1:570 HEIMER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5160
Practice Address - Country:US
Practice Address - Phone:210-885-3481
Practice Address - Fax:210-504-5084
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-82642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician